County Leadership Institute Nomination Form

June 12-16, 2022 | Washington, D.C.

The County Leadership Institute (CLI) is designed to provide county officials with the opportunity to address their most pressing leadership concerns in a small group setting. NACo will consider up to two nominations from each state association executive director and select one nominee to attend.

We particularly invite nominations of promising mid-career individuals who have demonstrated a receptivity to new ideas and a passion for being part of a learning team.

The deadline for nominations is May 16, 2022.

For more information on the County Leadership Institute, please contact Alana Hurley at ahurley@naco.org.

Nominating Organization Information

Your title *

Your name: *

Your organization: *

Your state: *

Your email address: *

CC Email (optional):

Nominee Information

Title: *

First Name: *

Last Name: *

County/Organization: *

State: *

Email address (NACo will use this email address to communicate with your nominee; please ensure you are entering their current email address): *

CC Email (optional):

Nomination Statement:

Would you like to nominate an alternate candidate? *

Yes

No

Title:

First Name:

Last Name:

County/Organization:

State:

Email address (NACo will use this email address to communicate with your nominee; please ensure you are entering their current email address):

CC Email:

Nomination Statement:

Invoicing Information

How will the program cost be supported? *

State association

Nominee's county

Partial state association and county

Other

If you selected other, please enter more information below. A billing contact is still required.

Amount to bill to state association:

Amount to bill to county:

Please enter billing information below. Please note that all tuition invoices must be paid in full prior to June 12, 2022.

State association billing contact email address: *

County billing email address:

Name: *

Street Address: *

Address Line 2:

City: *

State: *

Zip Code: *

Phone Number: *